Merten Jennifer, Eichelmann Ann-Kathrin, Mennigen Rudolf, Flammang Isabelle, Pascher Andreas, Rijcken Emile
Department of General, Visceral and Transplantation Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W1, 48149 Muenster, Germany.
MVZ Portal 10, Albersloher Weg 10, 48155 Muenster, Germany.
J Clin Med. 2021 Oct 14;10(20):4721. doi: 10.3390/jcm10204721.
The purpose of this study is to demonstrate that repetitive minor surgical procedures allow for a high rate of permanent closure of perianal fistulas in patients with Crohn's disease (CD). Patients with perianal fistulizing CD (PFCD) who underwent perianal surgery at the University Hospital of Muenster between 2003 and 2018 were assessed for fistula characteristics and surgical procedures. We included 45 patients (m:f = 28:17) with a mean age of 27 years at first fistula appearance. Of these, 49% suffered from a complex fistula. An average of 4.2 (1-14) procedures were performed, abscess incisions and fistula seton drainages included. Draining setons were left in place for 5 (1-54) months, until fistula closure. Final surgical techniques were fistulotomy (31.1%), seton removal with sustained biological therapy (26.7%), Anal Fistula Plug (AFP) (17.8%), Over-The Scope-Clip proctology (OTSC) (11.1%), and mucosa advancement flap (4.4%). In 8.9% of cases, the seton was kept as permanent therapy. The time from first to last surgery was 18 (0-182) months and the median follow-up time after the last surgery was 90 (15-200) months. The recurrence rate was 15.5% after 45 (17-111) months. Recurrent fistulas healed after another 1.86 (1-2) surgical re-interventions. The final success rate was 80%. Despite biological treatment, PFCD management remains challenging. However, by repeating minor surgical interventions over a prolonged period of time, high permanent healing rates can be achieved.
本研究的目的是证明，对于克罗恩病（CD）患者，重复性小手术可使肛周瘘管实现较高的永久性闭合率。对2003年至2018年间在明斯特大学医院接受肛周手术的肛周瘘管型CD（PFCD）患者的瘘管特征和手术过程进行评估。我们纳入了45例患者（男:女 = 28:17），首次出现瘘管时的平均年龄为27岁。其中，49%患有复杂性瘘管。平均进行了4.2（1 - 14）次手术，包括脓肿切开和瘘管挂线引流。引流挂线留置5（1 - 54）个月，直至瘘管闭合。最终的手术技术包括瘘管切开术（31.1%）、持续生物治疗下的挂线拆除术（26.7%）、肛瘘栓（AFP）（17.8%）、经内镜吻合夹直肠手术（OTSC）（11.1%）和黏膜推进皮瓣术（4.4%）。在8.9%的病例中，挂线作为永久性治疗保留。从首次手术到最后一次手术的时间为18（0 - 182）个月，最后一次手术后的中位随访时间为90（15 - 200）个月。45（17 - 111）个月后的复发率为15.5%。复发性瘘管在另外1.86（1 - 2）次手术再干预后愈合。最终成功率为80%。尽管有生物治疗，但PFCD的管理仍然具有挑战性。然而，通过在较长时间内重复进行小手术干预，可以实现较高的永久性愈合率。
